Chapter 7: Learning IV Medications Flashcards
Another name for a venous catheter
Line
Where is a common vein where a peripheral catheter can be inserted?
cephalic vein in the arm
What is a limitation of administering drugs into smaller veins?
Phlebitis (vein irritation), venous thrombosis and fluid extravasation
Where does a central line empty into?
larger veins
Central lines provide secure, long-term vascular access and are required for administration of:
- highly concentrated drugs
- long term antibiotics
- toxic drugs that can cause phlebitis (e.g. chemo)
- drugs with a pH or osmolality that is not close to blood pH or osmolality (e.g. parenteral nutrition)
Where can central lines be placed?
- Into a large vessel like the superior vena cava
- Into a smaller vein and advancing the catheter through the vein until the tip ends in the superior vena cava (called a PICC - peripherally inserted central catheter)
What are examples of common vesicants
- Vasopressors (dopamine, NE)
- Anthracyclines (e.g. doxorubicin)
- Vinca alkaloids (e.g. vincristine)
- Promethazine
Name 3 primary compatibility and stability sources for parenteral medications
- Trissel’s Handbook on Injectable Drugs
- King guide to Parenteral Admixtures
- Package insert
type of incompatabilities and examples
chemical: hydrolysis, oxidation, or decompensation
physical: the conainter (PVC), diluent (Dextrose or saline), another drug
Drugs that have leaching or adsorption/absorption issues with PCV containers can be placed in:
Polyolefin, polypropylene or glass containers (these are known as non-PVC containers)
Key drugs with leaching/adsorption/absorption issues with PVC containers
- Lorazepam
- Amiodarone
- Tacrolimus
- Taxanes
- Insulin
- Nitroglycerin
Remember: LATTIN
when people “LATTIN” dance they are very close and adsorb to each other
What are key drugs that cannot be put into dextrose & can only be used with saline?
- Daptomycin (cubicin)
- Infliximab (Remicade)
- Ampicillin
- Phenytoin (Dilantin)
- Ampicillin/sulbactam (Unasyn)
- Caspofungin (Cancidas)
- Ertapenem (Invanz)
Remember: DIAPACE
diabetics need to pace themselves with sugar so they have salt instead
also diabetics get a lot of infections so most of these are anti-infectives
What are key drugs that cannot be put into saline & can only be used with dextrose?
- Bactrim
- Oxaliplatin
- Amphotericin B
- Synercid (Quinupristin/Dalfopristin)
Remember: BOAS will strangle the pharmacist who puts these drugs into anything but dextrose
What are two examples of high-risk incompatibilities?
- Ceftriaxone and any calcium-containing solutions due to risk of precipitates (e.g. lactated ringers contains calcium and cannot be mixed with ceftriaxone)
- Calcium and phosphate
precipitates can lead to emboli
What is a 1.2 micron filter used for?
Lipids
what drug needs a 5 micron filter?
ampho B
What size filter should you use for parenteral nutrition?
0.22 micron filter, which will catch calcium-phosphate particulates
what size filter do most filtered medications need?
0.22 micron filter
What are common drugs with filter requirements?
- Golimumab
- Amiodarone
- Lorazepam (when administered by continuous infusion)
- Phenytoin (when administered by continuous infusion)
- Lipids (1.2 micron)
- Amphotericin B (lipid formulations; use 5 micron filter)
- Taxanes (except docetaxel)
Remember: That’s my GAL, PLAT or GALLTAP
Which key IV drugs crystalize if kept cold and are stored at room temperature?
- Dexmedetomidine (Precedex)
- Phenytoin (crystalizes)
- Bactrim (Sulfamethoxazole/Trimethoprim)
- Furosemide (crystalizes)
- Metronidazole
- Moxifloxacin (Avelox)
- Enoxaparin (Lovenox)
Remember: Dear Pharmacist, Being Frigid Makes Me Edgy
What are key drugs that must be protected from light during administration?
- Phytonadione (Vitamin K; Mephyton)
- Epoprostenol (Flolan)
- Nitroprusside (Nitropress)
- Micafungin (Mycamine)
- Doxycycline
Remember: Protect Every Necessary Med from Daylight
Or PM DEN
Which drugs are easily destroyed if shaken/agitated?
- Albumin
- Alteplase
- Immune globulins
- Insulins
- Etanercept
- Monoclonal antibodies
- Rasburicase
- Some vaccines, including zoster
Mostly proteins and hormones
In most cases, discoloration of a drug indicates ___ or ___
Oxidation
decompensation
Oxidation of dobutamine turns the solution slightly ____
Is potency lost?
Pink
no
If nitroprusside turns ____, it indicates complete dissociation to cyanide
- Blue
- Do NOT use
Which two IV drugs come as a red solution
Anthracyclines and rifampin
Which IV drug comes as a blue solution
Mitoxantrone
Physical incompatibilities occur between a drug and:
- The container
- The diluent
- Another drug
The majority of PVC containers use ____ as a “plasticizer” to make the plastic bag more flexible
DEHP
Why is DEHP dangerous in PVC containers
It’s toxic & can harm the liver and testes if it leaches from the container and into the solution
When drugs are put into solution for IV administration in the pharmacy, they are commonly placed in 50 mL or larger IV piggybacks that contain:
5% dextrose or 0.9% sodium chloride
Lactated ringers solution contains
Calcium
If compounding IV medications packaged in glass ampules, what is used to prevent particulates from entering the IV bag
Filter needles or filter straws
